Provider Demographics
NPI:1477276236
Name:CHAVIS, MARCIA REANEE (MBA, MA, LCASA)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:REANEE
Last Name:CHAVIS
Suffix:
Gender:F
Credentials:MBA, MA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 MISSOURI RD
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-8097
Mailing Address - Country:US
Mailing Address - Phone:910-374-9477
Mailing Address - Fax:
Practice Address - Street 1:86 THREE HUNTS DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-8998
Practice Address - Country:US
Practice Address - Phone:910-374-9477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27974101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty